Use and barriers to the use of telehealth services among the Arab population in Israel

Abstract Background Telehealth services tends to be used relatively infrequently by minority populations, thereby exacerbating health inequalities. This study examines the individual, circumstantial and environmental factors that facilitate or hinder usage of telehealth among Israeli Arabs, who constitute 21% of the Israeli population. Methods Data was collected through a telephone survey among the adult Arab population in October 2020 with 501 respondents (42% response rate). Analysis included logistic regression. Results Most of the Arab population use the internet several times a week (93%) and have a smartphone (96%). The most popular telehealth service was telephone appointments with a doctor (66%). Two thirds have never used the health plan’s mobile application, though most have no objection to using chat (75%) or video conversation (51%) with a medical professional. The most significant barrier to using telehealth is lack of awareness of services such as ordering medicines (23%). Conversely, factors that facilitate the use of telehealth include previous acquaintance with the doctor (91%); Arabic services (82%); and recommendation by health professionals (79%). Multivariate analyses indicate a strong positive correlation between education and the use of telehealth for written correspondence with a known health professional (p = 0.001). Conclusions Telehealth services (e.g., phone appointments) which are already used widely by the Israeli-Arab population, should be retained and developed further. In parallel, digital health literacy and linguistically and culturally adaptation of digital services should be promoted. Awareness of those services should be enhanced through culturally adapted marketing and via recommendations from the family doctor. Key messages • Identification of the barriers to the use of telehealth services among minority populations can help service providers reduce usage gaps between minority and majority population. • The use of telehealth services should be simplified to suit people with a low digital health literacy.


Background:
The German government undertakes efforts to implement DiGA into the statutory health insurance to improve its quality. DiGA are physician-prescribed applications for patients with certain diagnosed diseases, whose costs are covered by the statutory health insurers. DiGA have the potential to improve healthcare, but it is also possible, that the usage of these applications perpetuates existing health inequalities, summarized by the term Digital Divide; meaning that socially deprived populations are less able to benefit from digital technologies. The aim of this analysis is to determine whether differences exist in DiGA use by sociodemographic/ socioeconomic characteristics.

Methods:
The results based upon the analysis of an online survey involving 1,200 people (18-74 years) living in Germany between March 10 and March 18, 2022. The sample composition reflects the current distribution of age, gender, and place of residence in the federal states (uncrossed). The questionnaire focused, among other aspects, on the use of DiGA. A binary logistic regression was used for the analysis.

Results:
Compared to the lowest subjective social status (SSS), probands with a medium (OR 2.865) or a high SSS (OR 4.085) are more likely to use DiGA. Compared to the reference group (60 years and older), the 18-29-year-(OR 2.044) and the 30-39-year-olds (OR 1.952) tend to have a higher likelihood of using DiGA. The likelihood of the use decreases among probands with medium (OR 0.632) and high educational degree (OR 0.580) compared to the reference group (low education).

Conclusions:
In accordance with the results of existing studies, social differences could be identified regarding known determinants of health inequalities, like age and SSS. In this analysis, the highest degree of education does not appear as a predictor for an increased likelihood of use. Thus, further analyses are needed to address the influence of education, especially to develop a broader understanding of the DiGA use. Key messages: It appears that DiGA are not equally accessible or used across different population groups, and thus indicating an already existing or emerging Digital Divide regarding the use of DiGA. Contrary to the broad assumption that higher expressions of health determinants are related to a higher likelihood of using DiGA, a higher degree of education decreases the likelihood of using DiGA. telehealth service was telephone appointments with a doctor (66%). Two thirds have never used the health plan's mobile application, though most have no objection to using chat (75%) or video conversation (51%) with a medical professional. The most significant barrier to using telehealth is lack of awareness of services such as ordering medicines (23%). Conversely, factors that facilitate the use of telehealth include previous acquaintance with the doctor (91%); Arabic services (82%); and recommendation by health professionals (79%).
Multivariate analyses indicate a strong positive correlation between education and the use of telehealth for written correspondence with a known health professional (p = 0.001).

Conclusions:
Telehealth services (e.g., phone appointments) which are already used widely by the Israeli-Arab population, should be retained and developed further. In parallel, digital health literacy and linguistically and culturally adaptation of digital services should be promoted. Awareness of those services should be enhanced through culturally adapted marketing and via recommendations from the family doctor.
Key messages: Identification of the barriers to the use of telehealth services among minority populations can help service providers reduce usage gaps between minority and majority population.
The use of telehealth services should be simplified to suit people with a low digital health literacy.

Background:
This review aims to provide an overview of evidence on feasibility and effectiveness in diverse populations of eHealth physical activity (PA) community engagement (CE) interventions. Increasing global PA levels would have a substantial positive impact on population health. Given their diffusion, eHealth technologies may address certain barriers to PA and reach wide audiences. The most recent Italian guidelines on PA highlight inequalities in health, which can be addressed using CE models. The potential scalability of successful eHealth CE interventions and the scarcity of previous reviews on the topic are reasons which convinced us to work on this paper.

Methods:
This mixed-methods systematic review utilized the Joanna Briggs Institute methodologies. Primary quantitative outcome measures were minutes of PA per week. Qualitative outcome measures included self-efficacy and user engagement. Data were processed using a segregated convergent design. A narrative summary and a meta-aggregation were performed for synthesizing quantitative and qualitative data respectively. Only the interventions where CE principles were fulfilled were analyzed.

Results:
Quantitative evidence supported effectiveness and feasibility of interventions to improve PA outcomes and related proxy indicators across studied populations. Qualitative findings suggest the utility of peer-support and that from other health care providers.

Conclusions:
Implementing CE in future PA interventions will be critical for producing an effective digital application with the potential for considerable impact in the real world. If supported by central governments and the European Union, entities such as primary care hubs and local health units with their professionals and CE capabilities may play the key role in implementing evidence.